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A narrative synthesis of illustrative evidence on effects of capitation payment for primary care: lessons for Ghana and other low/middle-income countries

Francis-Xavier Andoh-Adjei
Ernst Spaan
Felix A Asante
Sylvester A. Mensah
Koos van der Velden


Objective: To analyse and synthesize available international experiences and information on the motivation for, and effects of using capitation as provider payment method in country health systems and lessons and implications for low/middle-income countries.

Methods: We did narrative review and synthesis of the literature on the effects of capitation payment on primary care.

Results: Eleven articles were reviewed. Capitation payment encourages efficiency: drives down cost, serves as critical source of income for providers, promotes adherence to guidelines and policies, encourages providers to work better and give health education to patients. It, however, induces reduction in the quantity and quality of care provided
and encourages skimming on inputs, underserving of patients in bad state of health, “dumping” of high risk patients and negatively affect patient-provider relationship.

Conclusion: The illustrative evidence adduced from the review demonstrates that capitation payment in primary care can create positive incentives but could also elicit un-intended effects. However, due to differences in country context, policy makers in Ghana and other low/middle-income countries may only be guided by the illustrative evidence
in their design of a context-specific capitation payment for primary care.

Funding: Netherlands Fellowship Programme (NFP), Fellowship number: NFP-PhD.12/352

Keywords: Capitation payment, primary care, cost-containment, national health insurance, Ghana